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Background and Purpose: The Life Space Assessment (LSA) is a self-report measure that allows clinicians to determine how often someone moves around in his or her environment with or without assistance. Presently, there are no reliable and valid measures that capture all 3 aspects of mobility (ie, mobility frequency, distance, and assistance needed) for individuals with vestibular disorders. The purpose of this studywas to describe life space and to determine the reliability and concurrent validity of the LSA as a tool to measure mobility and function in individuals with balance and vestibular disorders. Methods: One hundred twenty-eight participants (mean age of 55 ± 16.7 years) experiencing dizziness or imbalance who were seeking the care of an otoneurologist were recruited. Participants completed the LSA, Dizziness Handicap Inventory (DHI), and the 12-Item Short Form Health Survey (SF-12). Results: The mean LSA score of the sample was 75/120 ± 30. The LSA demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.91). The LSA was negatively correlated with the DHI total score (p = -0.326, P < 0.01), DHI physical subscore (p = -0.229, P=0.02), DHI functional subscore (p = -0.406, P<0.01), and DHI emotional subscore (p = -0.282, P < 0.01). The LSA was positively correlated with both the physical (p = 0.422, P < 0.01) and mental (p = 0.362, P < 0.01) composite scores of the SF-12. Discussion and Conclusions: Similar to the findings in communitydwelling older adults, the LSA demonstrated excellent test-retest and internal consistency in individuals with vestibular disorders. The LSA is a valid and reliable tool for measuring mobility and function in individuals with vestibular disorders. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background and Purpose: Persons with vestibular disorders are known to have slower gait speed with greater imbalance and veering during dual-task walking than healthy individuals, but the cerebral mechanisms are unknown. The purpose of this study was to determine whether individuals with visual vertigo (VV) have different cerebral activation during dual-task walking compared with control subjects. Methods: Fourteen individuals with VV and 14 healthy controls (CON) were included (mean 39 years old, 85% women). A cross-sectional experimental study consisting of 4 combinations of 2 surfaces (even and uneven) and 2 task conditions (single- and dual-task) was performed. Participants walked over an even (level flooring) or uneven (wood prisms underneath carpeting) surface, either quietly or while reciting every other letter of the alphabet. Changes in cerebral activation over the bilateral prefrontal cortices were recorded using functional near-infrared spectroscopy during 4 task conditions relative to quiet standing. Gait speed and cognitive performance were recorded. Results: There were no between-group differences in cognitive performance. Both groups slowed when walking on an uneven surface or performing a dual-task; participants in the VV group walked more slowly than those in the CON group in all conditions. Participants with VV had decreased cerebral activation in the bilateral prefrontal regions in comparison to CON participants in all conditions. Discussion and Conclusions: Participants with VV had lower prefrontal cortex activation than CON participants during dual-task walking. Lower cortical activity in those with VV may be due to shifted attention away from the cognitive task to prioritize maintenance of dynamic balance. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A303). [ABSTRACT FROM AUTHOR]

Falls are a major health care concern in individuals with Alzheimer disease (AD) and their caregivers. Vestibular impairment is a known risk factor for falls, and individuals with AD have been shown to have an increased prevalence of vestibular loss compared with age-matched controls. Vestibular physical therapy (VPT) is effective in improving balance and reducing fall risk in cognitively-intact persons with vestibular impairment. However, the effectiveness of VPT in improving balance and reducing falls in individuals with AD who have vestibular loss has never been explored. Summary of Key Points: In this article, we apply prevailing ideas about rehabilitation and motor learning in individuals with cognitive impairment (IwCI) to VPT. Recommendations for Clinical Practice: We propose a modification of current evidence-based VPT protocols for IwCI using the strength-based theoretical framework that emphasizes the motor learning abilities of IwCI. In addition, we highlight the importance of establishing an excellent rapport with IwCI, and present key strategies for optimizing the therapeutic relationship. In ongoing work, we are assessing the efficacy of this modified VPT protocol in IwCI to improve balance and reduce falls. [ABSTRACT FROM AUTHOR]

Background and Purpose: Deciphering the cause for a persistent, direction-changing geotropic nystagmus can be difficult. Migraine and light cupula are two possible causes, though can be confused with benign paroxysmal positional vertigo (BPPV) affecting the horizontal semicircular canal. In migraine, the persistent geotropic nystagmus tends to be slow; in light cupula, the nystagmus has been illustrated to beat in the direction opposite that of prone positioning. Case Description: Here we describe a patient with initial occurrence then recurrence of a high velocity (≥30 deg/sec), persistent direction-changing geotropic nystagmus and vertigo with an intensity variable based on head position, which was difficult to manage. This patient did not have migraine. The case presented uniquely as it was unlikely due to canalithiasis of the horizontal semicircular canal yet the presentation was not clearly related to the light cupula phenomena either. Intervention: In this case, the physical therapist attempted to use the barbeque roll canalith repositioning maneuver (CRM) even though the direction-changing geotropic nystagmus was persistent. The nystagmus did not resolve during the clinic visit. Outcomes and Discussion: The persistent, high velocity geotropic nystagmus resolved within 1 week, however, this resolution was likely spontaneous and not due to the CRM intervention. Our case suggests that physical therapists assessing persistent geotropic nystagmus should wait long enough for the nystagmus to stop (~2 minutes), test for fatigue by repeating the positional nystagmus tests, incorporate a head flexion component as part of the positional testing, and attempt to identify a null point. [ABSTRACT FROM AUTHOR]